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• W2887793910 abstract "To describe existing evidence on non-pharmacological interventions to manage sleep disturbance in children with neurodisabilities. We systematically reviewed non-pharmacological interventions aimed at improving non-respiratory sleep disturbance in children with neurodisability. Sixteen databases, grey literature, and reference lists of included papers were searched up to February 2017. Two researchers (B.B., C.M., G.S., A.S., A.P.) undertook screening, data extraction, and quality appraisal. Twenty-five studies were included: 11 randomized controlled trials and 14 before-and-after studies. All studies were at high or unclear risk of bias. Parent-directed interventions were categorized as comprehensive tailored interventions (n=9), comprehensive non-tailored interventions (n=8), and non-comprehensive interventions (n=2). Six ‘other’ non-pharmacological interventions were included. Seventy-one child and parent sleep-related outcomes were measured across the included studies. We report the two most commonly measured outcomes: the Child Sleep Habits Questionnaire and sleep onset latency. Five studies reported significant improvements on at least one of these outcomes. Various types of non-pharmacological intervention for managing sleep disturbance have been evaluated. Clinical heterogeneity and poor study quality meant we could not draw definitive conclusions on the effectiveness of these interventions. Current clinical guidance recommends parent-directed interventions as the first approach to managing sleep disturbance; prioritizing research in this area is recommended. Describir la evidencia existente sobre intervenciones no farmacológicas para controlar la alteración del sueño en niños con discapacidades neurológicas. Revisión sistemática de intervenciones no farmacológicas destinadas a mejorar la alteración del sueño de causa no respiratorio en niños con discapacidades neurológicas. Se realizaron búsquedas en dieciséis bases de datos, literatura gris y listas de referencias de documentos incluidos hasta febrero de 2017. Dos investigadores llevaron a cabo exámenes de detección, extracción de datos y evaluación de la calidad. Se incluyeron veinticinco estudios: 11 estudios controlados aleatorios (ECA) y 14 estudios observacionales - antes y después. Todos los estudios tenían un riesgo de sesgo alto o poco claro. Las intervenciones dirigidas a los padres se categorizaron como: intervenciones integrales a medida (n = 9), intervenciones integrales no adaptadas (n = 8), intervenciones no integrales (n = 2). Seis “otras” intervenciones no farmacológicas se incluyeron. Se midieron los resultados relacionados con el sueño de 71 niños y padres a través de los estudios incluidos. Presentamos los dos resultados más comúnmente medidos: Cuestionario de Hábitos de Sueño Infantil y Latencia de Inicio del Sueño. Cinco estudios informaron mejoras significativas en al menos uno de estos resultados. Se han evaluado diversos tipos de intervenciones no farmacológicas para controlar la alteración del sueño. Debido a la heterogeneidad clínica y la mala calidad de los estudios no pudimos sacar conclusiones definitivas sobre la efectividad de estas intervenciones. La guía clínica actual recomienda las intervenciones dirigidas por los padres como el primer enfoque para manejar la alteración del sueño; se recomienda priorizar la investigación en esta área. Registro de revisión: registro de PROSPERO: CRD42016034067 Descrever a evidência existente sobre intervenções não-farmacológicas para manejo de distúrbios do sono em crianças com neuro-incapacidades. Revisão sistemática de intervenções não-farmacológicas visando melhorar distúrbios do sono não respiratório em crianças com neuro-incapacidades. Dezesseis bases de dados, literatura cinzenta, e listas de referências dos artigos incluídos foram buscados até Fevereiro de 2017. Dois pesquisadores fizeream a busca, extração de dados, e avaliação de qualidade. Vinte e cinco estudos foram incluídos: 11 ensaios clínicos randomizados (ECRs) e 14 estudos antes-depois. Todos os estudos tiveram risco alto ou não esclarecido de vieses. Intervenções direcionadas para os pais foram categorizadas como: intervenções personalizadas compreensivas (n=9), intervenções não personalizadas compreensivas (n=8), intervenções não-compreensivas (n=2). Seis “outras” intervenções não-farmacológicas foram incluídas. Setenta e um desfechos relacionados ao sono de crianças e pais foram mensurados nos estudos incluídos. Relatamos os dois desfechos mais frequentemente mensurados: Questionário dos Hábitos de Sono da Criança, e Latência para Início do Sono. Cinco estudos relataram melhoras significativas em pelo menos uma destas medidas. Vários tipos de intervenções não-farmacológicas para manejo dos distúrbios do sono foram avaliados. A heterogeneidade clínica e a pobre qualidade dos estudos implicam que não podemos tirar conclusões definitivas sobre a efetividade destas intervenções. As recomendações clínicas atuais apontam intervenções direcionadas aos pais como a primeira abordagem no manejo de distúrbios do sono; priorizar pesquisas nesta area é recomendado. Registro da revisão: registro PROSPERO CRD42016034067 This article's abstract has been translated into Spanish and Portuguese. Follow the links from the abstract to view the translations. Non-respiratory sleep disturbances are more prevalent in children with neurodisabilities than in typically developing children.1, 2 Sleep problems can affect quality of life, school performance, and daytime behaviour.3, 4 Child sleep problems are also associated with poor outcomes for parents and other members of the household.5 Current guidance on management of sleep disturbance in children proposes that once clinical or respiratory reasons for sleep disturbance are excluded, interventions that aim to change parents’ management of their child's sleep should be the ‘first port of call’.6 This guidance is regarded as applicable to children with neurodisability. Pharmacological interventions (such as melatonin) are recommended where such interventions prove ineffective or alongside parent-directed approaches.7, 8 Other non-pharmacological approaches include chronotherapy, phototherapy, dietary interventions, sensory interventions (e.g. weighted blankets), cranial osteopathy, and environmental changes. Previous systematic reviews in the field of managing sleep disturbance in children with neurodisabilities have mainly focused on individual diagnoses9-14 and/or a specific intervention or pharmacological intervention only.10, 13-15 A systematic review was therefore commissioned by the UK National Institute for Health Research (NIHR), Health Technology Assessment (HTA) Programme to collate the existing evidence across multiple interventions and neurodisabilities. We aimed to assess the effectiveness of non-pharmacological interventions for non-respiratory sleep disturbance in children with neurodisabilities and to identify priorities for future primary research. The review reported here is part of a broader review, which also included pharmacological interventions and will be available as an NIHR HTA journal report (https://www.journalslibrary.nihr.ac.uk/programmes/hta/1421202/#/). The review was conducted in accordance with the Centre for Reviews and Dissemination's guidance for undertaking reviews in health care16 and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.17 The review was prospectively registered with PROSPERO (registration number CRD42016034067).18 As this paper represents a systematic review of published work, ethical approval was not required. Studies were assessed against the eligibility criteria described in the following sections. Children and young people (0–18y) with neurodisability and experiencing non-respiratory sleep disturbance were included. Neurodisability was defined in accordance with the consensus definition of Morris et al.19 Non-respiratory sleep disturbances of any duration relating to initiation, maintenance, or scheduling of sleep, diagnosed by a health care professional on the basis of parental/carer or child report or sleep observation, were included. Central disorders of hypersomnolence and sleep-related movement disorders were excluded. Non-pharmacological interventions aimed at improving sleep initiation, maintenance, scheduling, or quality in any setting, which are relevant to the care provided by statutory health care services across the UK, were included. Interventions had to meet current practice standards20 on the basis of guidance from clinical members of the team (e.g. interventions that involved punishment were not eligible). Studies using no comparator, wait list control, placebo, or other active intervention were eligible. The primary outcomes of interest were child- and parent-related sleep. These included actigraphy-based and parent/carer- or child-reported measures (e.g. sleep diaries, or standardized scales relating to initiation, maintenance, scheduling, or quality of sleep). Secondary outcomes included child-related quality of life; daytime behaviour and cognition; parent/carer quality of life and well-being including global quality of life, physical well-being, mental well-being, mental health (e.g. stress) and family functioning; and adverse events. Randomized controlled trials (RCTs), non-randomized controlled studies, and before-and-after studies were eligible. Case studies were excluded. An information specialist searched the following electronic databases in February and March 2016 and updated the search in February 2017: Applied Social Sciences Index of Abstracts (ASSIA); The Cochrane Central Register of Controlled Trials (CENTRAL); Cochrane Database of Systematic Reviews; Conference Proceedings Citation Index; Cumulative Index of Nursing and Allied Health Literature (CINAHL); Database of Abstracts of Reviews of Effects; Embase; Health Management Information Consortium; MEDLINE; MEDLINE In-Process; PsycINFO; Science Citation Index; Social Care Online; and Social Policy & Practice. ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform; and the UK Clinical Trials Gateway were also searched for ongoing and completed trials. An example search strategy (for ASSIA) is provided in Appendix S1 (online supporting information). There were no restrictions on date, language, or study design. The search results were downloaded into Endnote bibliographic software (Clarivate Analytics, Philadelphia, PA, USA) and deduplicated. The first 10% of titles were screened independently by two researchers (B.B., C.M., G.S., A.S., A.P.). Once agreement had been reached, a single researcher (A.S., A.P.) screened the remainder. Two researchers (B.B., C.M., G.S., A.S., A.P.) independently screened the abstracts of the records identified as potentially relevant on the basis of their title. Full papers were independently screened by two researchers (B.B., C.M., G.S., A.S., A.P.). Discrepancies were resolved through discussion and consensus with a third researcher (C.M.) if necessary. Data extraction forms were developed and piloted in Microsoft Word 2010 and Excel 2010. Data extracted included details of study design, descriptions of the intervention and comparator, outcome measures, and methods of assessment. Outcome data were extracted to allow calculation of the mean difference and 95% confidence interval (CI) between groups to assist comparison between studies. Data extraction was undertaken by one researcher and checked by a second (A.S., A.P.). Risk of bias was assessed using the Cochrane Risk Of Bias Tool for RCTs,21 A Cochrane Risk Of Bias Assessment Tool for Non-Randomized Studies of Interventions for other studies with a control group,22, 23 or an adapted checklist for before-and-after studies.24 For crossover trials, we also assessed whether an appropriate analysis using paired data was conducted and whether there was a treatment-by-period interaction.25 Assessment of risk of bias was undertaken independently by two researchers (B.B., C.M., G.S., A.S., A.P.), with discrepancies resolved through consensus, or discussion with a third researcher (C.M.). The substantial heterogeneity of interventions, study design, and outcome measures across studies meant meta-analysis was not appropriate. Therefore, narrative summaries are used to describe the available evidence. Interventions were assigned to the following categories: parent-directed and ‘other’ non-pharmacological interventions (Appendix S2, online supporting information). Parent-directed interventions were defined as psycho-educational interventions aiming to teach parents knowledge and skills to manage their child's sleep disturbance and possibly to provide support to parents as they implement new knowledge and skills. Modes of delivering such interventions include one-to-one sessions, group work, one-off workshops, and provision of written material. Given the variety within this category of intervention, these were classified in terms of their content (comprehensive vs non-comprehensive) and the degree to which they were personalized to the individual child (tailored vs non-tailored). The following intervention typology was created: Other types of non-pharmacological intervention included interventions such as complementary therapies and weighted blankets. Studies were grouped by intervention type, study objective (evaluations of intervention effectiveness, evaluations of different modes of delivering an intervention or intensity of support), and then by study design (RCT and non-randomized study designs) for the synthesis. After deduplication 15 745 titles were screened and 25 studies investigating non-pharmacological interventions were included (Fig. 1). A list of excluded studies is available from the authors. Table 1 summarizes key study characteristics, grouped by the type of intervention evaluated. Eleven RCTs, one controlled before-and-after study, and 14 uncontrolled before-and-after studies were included. Studies were conducted in the UK (n=9), USA (n=7), Australia (n=5), and one each in Canada, Hong Kong, Israel, and China. Sample sizes ranged from 5 to 244 participants. Austin et al.50 Australia Before-and-after study n=8 4:0 (1:11) Mixed Beresford et al.5 Associated papers64-66 UK Parallel group RCT n=13 I: n=7 C: n=6 I: Two face-to-face sessions for assessment, development of sleep management and parent training strategies. Telephone implementation support C: Usual approach to providing SMI: as above, but implementation support by home visit I: 2:10 (0:10) C: 2:8 (1:00) Mixed Beresford et al.5 intervention 2 Associated papers64-66 UK Before-and-after study n=12 2:11 (1:35) Mixed Hiscock et al.35 Associated paper67 Australia Parallel group RCT n=244 I: n=122 C: n=122 I: One assessment session, development of sleep management and parent training strategies. Implementation support by one face-to-face session and one telephone call C: Usual care: routine access to health care from paediatrician, where required. Sleep issues not routinely addressed I: 10:4 (1:10) C: 9:11 (2:1) ADHD+learning disability or ASD/Asperger syndrome Johnson et al.27 Associated paper68 USA Parallel group RCT n=40 I: n=20 C: n=20 I: One assessment session, development of sleep management strategy, five sessions training parent in strategy. Face-to-face implementation support C: Non-sleep-related parent education delivered in identical manner to intervention group I: 3:6 (1:00) C: 3:7 (1:1) Autism and ASD Moss et al.28 Associated papers68, 69 Australia Parallel group RCT n=26 I: n=13 C: n=13 I: Two training workshops, home visit for assessment, and development of sleep management strategy. Implementation support by home visit and telephone calls as required. C: Waiting list control 11:9 (2:6) (not reported separately) Mixed Quine and Wade43 Associated paper70 UK Before-and-after study n=25 Mean (SD) not reported (range 3–21y) Learning disability Sciberras et al.29 Associated papers70-72 Australia Parallel group RCT n=27 I: n=14 C: n=13 I: Two assessment sessions, development of sleep management strategy, training parent in strategy. Implementation support by telephone call and face-to-face visit if needed C: Single assessment session, development of sleep management strategy, and training parent in strategy. No implementation support I: 12:1 (2:2) C: 10:11 (2:6) ADHD Weiskop et al.51 Australia Before-and-after study n=13 5:1 (2:0) Mixed Adkins et al.30 Associated paper70 USA Parallel group RCT n=36 I: n=18 C: n=18 I: Training curriculum in a booklet given to parent C: No booklet provided 6:5 (2:7) (not reported separately) Mixed Beresford et al.5 intervention 3 Associated papers64-66 UK Before-and-after study n=22 8:11 (3:3) Mixed Beresford et al.5 intervention 4 Associated papers64-66 UK Before-and-after study n=25 7:0 (3:4) Mixed Bramble44 Associated paper73 UK Before-and-after study n=15 7:2 (2:7) Mixed Malow et al.31 USA Parallel group RCT n=80 I: n=39 C: n=41 I: Training curriculum delivered by two group sessions. Implementation support by telephone calls C: Training curriculum delivered by single face-to-face session. Implementation support delivered by telephone calls I: 5:11 (2.8) C: 5:7 (2.6) Mixed Montgomery et al.26 Associated paper26 UK Parallel group RCT n=82 Ia: n=22 Ib: n=34 C: n=26 Ia: Training curriculum contained in a booklet given to parent Ib: Training curriculum identical to that in booklet delivered face-to-face C: Waiting list Mean (SD) not reported (range 27–101mo) (not reported separately) Mixed Reed et al.48 Associated paper74 Canada Before-and-after study n=22 5:10 (2:8) ASD Yu et al.38 Hong Kong Before-and-after study n=54 4.78y (0.85) ASD and Asperger syndrome Peppers et al.47 USA Before-and-after study n=23 Mean (SD) not reported (range 5–11y) Neurodisability not reported Wiggs and Stores34 Associated papers73, 75 UK Cluster RCT n=30 I: n=15 C: n=15 I: 8:2 (2:8) C: 10:9 (3:10) Mixed Gringras et al.32 UK Crossover RCT n=73 I: weighted blanket 2.25kg (small) 4.5kg (large) 12–16d, given by researchers at home/clinic visits C: placebo blanket Weighted blanket first: 8:8 (3:4) Control blanket first: 9:11 (2:10) Mixed Guilleminault et al.37 USA Before-and-after study n=14 2:11; range 9mo to 4y Moderate to severe intellectual disability Oriel et al.40 USA A–B–A withdrawal design n=8 8:11 (SD not reported range 6–11y) ASD Piazza et al.36 USA Parallel group RCT n=14 I: n=7 C: n=7 I: Faded bedtime with response costs 10d. Study author delivered face-to-face home visits and booklet intervention C: Bedtime scheduling, consistent sleep and wake time, and prevention of daytime sleep I: 6:8 (2:7) C: 8:4 (3:0) Mixed Yehuda et al.46 Israel Controlled before-and-after study n=78 I: n=40 C: n=38 (Healthy control n=22 not included) I: Essential fatty acid supplement 90g α-linolenic and 160g of linoleic acid in mineral oil. Two capsules per day for 10wks C: Placebo Mean (SD) not reported (range 9–12y) ADHD Yu and Hong39 China Before-and-after study n=30 6:11 (3:1) ‘Mental retardation’ The mean age of children ranged from 2 years 8 months to 12 years 1 month. Thirteen studies included children with two or more neurodisabilities. In nine studies, participants were described as having a single neurodisability diagnosis: autism spectrum disorder (n=6) or attention-deficit–hyperactivity disorder (ADHD) (n=3). The remaining three studies offered no detail on the types of neurodisability represented; generic terms such as ‘mental retardation’ were used. Most studies included children with a mix of sleep disturbances, with the most commonly reported being sleep initiation and maintenance (n=14 studies). The first time-point at which outcomes were measured once the intervention was completed ranged from immediately after intervention to 2 months after intervention. Five trials collected outcome data at additional follow-up time points; however, to minimize heterogeneity in results we only report outcomes measured closest to the end of the intervention. Poor reporting of study methods and results was found across all study designs. All RCTs were assessed as having high risk of bias for most items on the Cochrane Risk of Bias tool because of issues with randomization and incomplete outcome data. We were unable to find a registered protocol for 10 RCTs,5, 26-34 and in all RCTs blinded outcome assessment was either not undertaken or it was unclear whether blinding had occurred.5, 26-32, 34-36 However, we do note that the type of interventions and outcomes under investigation make robust, blinded outcome assessment challenging. Although the use of actigraphy data may be considered more objective than parent-reported data in terms of the measurement of some sleep outcomes, we did not consider these to be true objective outcomes with non-blinding likely to introduce bias. Non-randomized studies were at high (n=12) or unclear (n=2) risk of bias. This was mainly because of how studies selected participants (e.g. not reporting eligibility criteria)37-50 and likely or unclear bias in measurement of intervention outcomes.39, 40, 43-46, 51 Seventy-one sleep-related outcomes were reported across the included studies. Given the number of outcomes assessed, in this paper we only report the two most commonly measured outcomes: Child Sleep Habits Questionnaire (CSHQ),52 and sleep onset latency (SOL). The CSHQ is a parent-report questionnaire which is widely used to measure sleep disturbance. The questionnaire has 33 items, rated on a 3-point Likert scale. Items are grouped into the following subscales: bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep disordered breathing, and daytime sleepiness. A total score offers an overall measure of sleep disturbance, with higher scores indicating a greater severity of sleep disturbance, owing to either the frequency (i.e. regularity) or number of different behaviours presenting. However, caution is needed when using the scale as the sole method of assessing a child's sleep problems as a number of subscales showed low construct validity and diagnostic validity.53 No clinically important difference has been established for either the CSHQ or SOL. At least one of these outcomes was reported by most included studies. Six studies did not report either of these outcomes.26, 34, 36, 37, 43, 46 Full data on all outcomes are provided in the HTA report (https://www.journalslibrary.nihr.ac.uk/programmes/hta/1421202/#/). Five RCTs5, 27-29, 35 and four before-and-after studies5, 43, 50, 51 evaluated comprehensive tailored interventions, delivered face-to-face (at home and/or in clinic) (Table 2). The duration of the intervention, the number of sessions delivered, and the extent of implementation support varied across studies. Face-to-face. One (home) Home visit: approximately weekly for 6–8wks. Versus telephone call: approximately weekly for 6–8wks Face-to-face. One (home or clinic) Face-to-face. Five (home and clinic) Teaching workshops and face-to-face. Two workshops and one face-to-face (home) Face-to-face. One (clinic) vs two (clinic) None Versus telephone call (n=1) followed by face-to-face session (clinic) if needed Teaching workshops and face-to-face. Two workshops and one home visit and one workshop Face-to-face. Two (clinic, home) Face-to-face. Two (home) Face-to-face. Four (mix of home and clinic), plus at least weekly telephone contact between sessions Of the five RCTs, three used a no-intervention comparator,27, 28, 35 and two evaluated alternative ways of delivering an intervention: one compared the mode of implementation support (home visit vs telephone call);5 and the other compared the intensity of practitioner involvement when delivering the intervention (brief vs extended).29 CSHQ. Four RCTs (n=310)5, 28, 29, 35 and two before-and-after studies (n=20)5, 50 reported the CSHQ total score, a validated parent-reported global assessment of child sleep (Table 3). One RCT, which was classified as having low risk of bias on all domains except for performance bias (n=244), reported a statistically significant reduction (i.e. improvement) in total CSHQ score after intervention for the ADHD-specific intervention compared with usual care (adjusted mean difference −6.6 95% CI: −8.5 to −4.6).35 Another smaller RCT (n=26) reported a similar magnitude of effect but was not statistically significant (mean difference −4.62 95% CI: −10.83 to 1.59).28 In one before-and-after study there was an improvement in total CSHQ score after intervention compared with preintervention (mean difference −7.9 95% CI: −14.4 to −1.3).50 I: 59.50 (11.82) C: 53.33 (4.27) I: 52.17 (11.44) C: 53.33 (8.76) I: 57.8 (8.8) C: 59.0 (7.8) I: 50.1 (8.3) C: 55.1 (8.6) Adjusted: −6.6 (−8.5 to −4.6)b −5.0 (−7.6 to −2.4)a I: 56.20 (9.38) C: 51.38 (7.54) I: 46.50 (7.29) C: 51.12 (6.51) I: (change score) 5.09 (5.12) C: (change score) 6.82 (8.02) For the two trials investigating alternative approaches to delivering the intervention, no statistically significant difference in CSHQ score was observed.5, 29 SOL. One RCT (n=40)27 and two before-and-after studies (n=21)50, 51 measured SOL, the time from bedtime to sleep onset. There was no statistically significant difference in actigraphy-measured SOL (verified using sleep diaries) in the RCT of a comprehensive tailored intervention compared with an attention placebo control (non-sleep-related parent education) (mean difference 4min 95% CI: −15.0 to 23.0).27 One before and after the study also reported no statistically significant difference before and after the intervention in sleep-diary-measured SOL (mean difference 43min 95% CI: −30 to 116);50 the second presented the results as graphs with no numerical data available.51 Three RCTs and five before-and-after studies evaluated comprehensive non-tailored interventions.26, 30, 31, 38, 44, 48, 54 Various modes of delivery were used across the studies (Table 4). They also varied in the extent to which they accommodated the specific information and training needs parents might have had for their child's condition and/or sleep problem. Some included telephone implementation support, whereas others did not. One RCT compared a sleep training curriculum delivered by a booklet with no intervention;30 one compared two modes of delivering the same curriculum group versus individual face-to-face sessions supplemented by weekly telephone calls;31 and one compared group with individual delivery of a training curriculum.26 The before-and-after studies evaluated a group-delivered intervention;38, 42, 48 a single session workshop;41 and an individually delivered intervention.44 CSHQ. One RCT (n=80)31 and four before-and-after studies (n=126)38, 41, 42, 48 reported CSHQ total score. The RCT reported no statistically significant difference for this outcome between delivery of the training curriculum via a group or a single face-to-face session (not possible to calculate effect estimate and 95% CI).31 Two before-and-after studies, one evaluating a three-session group-delivered intervention48 and the other a four-session group-delivered intervention plus implementation support,38 reported statistically significant improvements (i.e. a decrease) in CSHQ total score after intervention compared with preintervention (mean difference −6.9 95% CI: −2.6 to −11.248 and mean difference −3.3 95% CI: −1.4 to −5.338 respectively). For the two other before-and-after studies, the mean difference in total CSHQ score could not be calculated before and after the intervention as the samples were not matched. However, the studies reported small or very small effect sizes of 0.20 and 0.02.41 SOL. Two RCTs (n=116)30, 31 and two before-and-after studies (n=40)44, 48 reported SOL. No statistically significant difference in SOL was observed in the RCT comparing a non-tailored intervention with no intervention (mean difference −11.8 95% CI: −37.3 to 13.7),30 the RCT comparing individual versus group delivery of the same training curriculum (mean difference −0.2 95% CI: −9.9 to 9.5),31 or in the before-and-after study of a group-delivered intervention (data not presented, narrative report provided only).48 The second before-and-after study reported a statistically significant reduction in SOL after receipt of a non-tailored comprehensive intervention delivered by a single face-to-face session (mean difference −42.8 95% CI: −6.01 to −24.6).44 One RCT and one before-and-after study34, 47 evaluated non-comprehensive interventions (Table 5). Wiggs and Stores34 Randomized controlled trial Peppers et al.47 Before-and-after study The RCT (n=30) evaluated an intervention that focused specifically on behavioural principles of managing problem sleep.34 The comparator was an attention control. Neither CSHQ nor SOL were reported in this study. The before-and-after study (n=23) evaluated an intervention47 that trained parents of children with ADHD on the principles of sleep hygiene only. This study reported a statistically significant improvement in CSHQ total score at 6 weeks after intervention (mean difference 6.4 95% CI: 4.3–8.5). Two RCTs and four before-and-after studies evaluated other types of non-pharmacological intervention (Tables 1 and 6).32, 36, 37, 39, 40, 46 Participants used the blanket for 12–16d Blanket received at home or clinic ‘Average treatment length 8wks’. Face-to-face (hospital) 60min of aquatic exercise two times a week Unclear Two capsules for 10wks Unclear Two courses of acupuncture treatment were given once every other day, three times a week, with 36 sessions constituting one course Ear point taping was given three times a week, with 36 sessions constituting one course. Two courses were required Unclear CSHQ. One study reported the CSHQ; there was a statistically significant reduction in total CSHQ score in the before-" @default.
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• W2887793910 title "Non-pharmacological interventions for non-respiratory sleep disturbance in children with neurodisabilities: a systematic review" @default.
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